Disorders of the Pleura (ch.14)

Question 1

What are the 3 main types of pleural disorders?

Answer 1

Pleural effusion, chylothorax, and hemothorax

Question 2

How do pleura disorders happen?

Answer 2

Manifests from illness injury, medication, or reactions to meds

Question 3

Which pleura disorder is most common?

Answer 3

pleural effusion

Question 4

What is pleural effusion?

Answer 4

Pleural effusion is an abnormal collection of fluid in the pleural space and is the most common manifestation of pleural disease.

Question 5

What are the 2 types of pleural effusions and describe each

Answer 5

Transudative pleural effusion = is caused by an imbalance in oncotic and hydrostatic pressures in the pleural space.

Exudative pleural effusion = is caused by inflammation of the pleura or decreased lymphatic drainage

Question 6

What are the major causes of transudative pleural effusion?

Answer 6

Congestive heart failure, hepatic cirrhosis, nephrotic syndrome, peritoneal dialysis, pulmonary embolism, and congenital heart disease

Question 7

What is the key difference between transudate and exudate in pleural effusion?

Answer 7

Exudate is rich in protein and LDH, while transudate is low in protein and LDH.

Question 8

What is the primary diagnostic method to differentiate between transudate and exudate?

Answer 8

Fluid aspiration by thoracentesis and pleural fluid analysis

Question 9

What is the clinical presentation of pleural effusion?

Answer 9

Symptoms may include dyspnea, mild cough, pleuritic chest pain, and asymmetry in chest expansion. Severe effusions may cause inaudible breath sounds, dullness to percussion, and hypoxemia

Question 10

What is the management for pleural effusion?

Answer 10

Treatment includes drainage, surgical interventions, pleurodesis, decortication, and addressing the underlying disorder

Question 11

What is pleurodesis?

Answer 11

insufflating talc directly into the pleural space to manage pleural effusions

Question 12

What is decortication procedure?

Answer 12

a procedure that involves removing the outer layer of an organ or structure, such as the pleura (manages pleural effusions)

** other procedures includes: Therapeutic thoracentesis -> remove larger amounts of pleural fluid, Complicated effusions -> drainage by thoracostomy**

Question 13

With severe pleural effusion what is classic presentations?

Answer 13

asymmetrical chest expansion diminished expansion on the side of the effusion mediastinal shift away from the effusion
Increased PIP and PPLAT and Hypoxemia if intubated

Question 14

What is chylothorax?

Answer 14

Chylothorax is the presence of chyle in the pleural space, often secondary to leakage from the thoracic duct, caused by trauma or obstruction

Question 15

Chylothorax is also known as

Answer 15

chylo pleura

Question 16

What are common non-traumatic causes of chylothorax?

Answer 16

Malignancies (50%), idiopathic causes, congenital issues, cirrhosis, tuberculosis, sarcoidosis, amyloidosis, and filariasis.

Question 17

What are common traumatic causes of chylothorax?

Answer 17

Surgical trauma (cardiothoracic 69%-85%)
Penetrating trauma (25%)

Question 18

What does pathophysiology look like for chylothorax?

Answer 18

Right-side accumulation of chylous fluid in the pleural cavity leaking from the thoracic duct accumulates in the pleural cavity, usually on the right side, and causes acute or chronic alterations in the pulmonary mechanics.

Question 19

What are the specific symptoms of chylothorax?

Answer 19

hypoalbuminemia
nutritional compromise
metabolic complications

Question 20

How can chylothorax be diagnosed?

Answer 20

• Ingestion of lipophilic dye or radio-labeled triglyceride: presence of the dye color in the fluid within 1 hour or detection of high radioactivity in the pleural fluid after 48 hours
• Lymphangiography
• CT of the thorax and abdomen: identify the site of thoracic duct rupture Lymphoscintigraphy

Question 21

REVIEW CARD: Chylothorax presents as…
- Spontaneous chylothorax may rarely present as a sudden neck mass
- Hypoalbuminemia and lymphopenia

Answer 21

REVIEW CARD: Chylothorax presents as…
- Spontaneous chylothorax may rarely present as a sudden neck mass
- Hypoalbuminemia and lymphopenia

Question 22

Who gets a surgical intervention with thoracic duct if a patient has chylothorax? (4)

Answer 22

1. Average daily loss exceeds 1 L to 1.5 L per year of age in children for a 5-day period
2. chyle flow has not diminished over 14 days
3. nutritional complications appear imminent, or
4. accumulation of chyle is continuous despite chest tube drainage

(Video-assisted thoracic surgery and fluoroscopic percutaneous embolization
A pleuroperitoneal shunt
Talc pleurodesis for malignant chylothorax)

Question 23

What is hemothorax?

Answer 23

Hemothorax is the presence of blood in the pleural space, usually secondary to trauma or iatrogenic causes

Question 24

What are common causes of hemothorax?

Answer 24

Penetrating injuries, blunt trauma, iatrogenic causes like central venous catheter or thoracostomy tube placement, and spontaneous occurrences

Question 25

How does hemothorax look like in the body?

Answer 25

Fibrothorax traps the lung in position and prevents it from full expansion, causing persistent atelectasis of portions of the lung and reduction in pulmonary function

Question 26

How can you detect a hemothorax?

Answer 26

- Upright chest radiograph - Ultrasonography - CT - Bedside echocardiography - Hematocrit of pleural fluid in nontraumatic cause

Question 27

How can a patient present with a diagnosed hemothorax?

Answer 27

- Hypoxemia, diminished ipsilateral breath sounds and dull percussion, hypotension, tachycardia in severe cases - In nontraumatic hemothorax: depends on the underlying pathology -Hemothorax due to acute hemorrhage from structures within the chest, such as arteriovenous malformation, can produce profound hemodynamic changes and symptoms of shock. - Occult hemorrhage: dyspnea, anemia, dullness to percussion, and decreased breath sounds over the area of the hemothorax

Question 28

How do you treat a hemothorax?

Answer 28

Tube thoracostomy drainage (70% to 80%), but not with significant pleural adhesions Video-assisted thoracoscopic surgery